Millennials, Manliness, and Mental Health: What Needs to Change?

At 20 years old, Gabe (a pseudonym) had nowhere to go but up. In just the last six months, he had dropped out of college, been hospitalized for suicidality, and gambled away thousands of dollars on basketball games. Now his parents were at their wits’ end, threatening to kick him out of the house for smoking cannabis “all day long.” Gabe’s response: “Do it. I’d rather be homeless.”

We all might be forgiven for holding a little countertransference toward Gabe. In truth, in my ever-evolving experience as a psychiatry resident approaching the end of training, young men with substance use disorders can be particularly difficult to treat. The very traits that society often glorifies in young men—risk taking, determination, “swagger”—backfire when they are applied to the pursuit of substances. Unfortunately, in the 2011 National Survey on Drug Use and Health, males were almost twice as likely as females to report using illicit drugs.

Many times, however, behind the bravado there is real pain. Eventually, in one of our visits, I learned that Gabe’s life had originally taken a turn for the worse after a bad breakup with a girlfriend. As their relationship deteriorated, he had become suicidal, dropped out, and had not returned to school since. For the first time in our work together, he broke down and cried in our meeting.

We talk of “toxic masculinity” and its impact on society, but increasingly scholars have argued that these beliefs are actually profoundly damaging to men as well. Men, enacting gendered norms about toughness and self-sufficiency, are less likely to go to the doctor, more prone to view depression as “weakness,” and more likely to die by suicide. Like Gabe, those who endorse more masculine beliefs and behaviors have been linked to higher rates of binge drinking, cannabis use, nonmedical use of prescription drugs, and smoking. Also, women who endorse more of a masculine gender identity are more likely to binge drink.

One could point to numerous theoretical culprits for this connection, including emotion suppression and glorification of risk-taking, but with young men like Gabe, the danger is that the problem is primed to get even worse. Not only are young men constantly buffeted by waves of messages reinforcing the idea that “real men” cannot show vulnerability, but they now live in an era of near-unfettered access to cannabis and the internet—which includes social media, gambling, pornography, and gaming. After Gabe quit school, he had access to sports betting and his ex’s Instagram posts 24/7 via his smartphone while confining himself entirely to his parents’ basement. When, at his parents’ urging, he finally got a job, it was at a cannabis company.

I feel for men like Gabe, who certainly have made some bad decisions, but who also face temptations the likes of which even their fathers have never known. Thus, I believe today’s young men, despite the societal privileges afforded to them, may actually need not less, but more help now that the opportunities for them to turn to self-destructive ideologies about manhood and substance use are only growing.

Women and disadvantaged populations that have been victimized in various ways are just now receiving the proper attention and focus that they have always been due. Justly, many of these efforts have also highlighted the historical role of men in creating these unfair outcomes. Thus, it is notable to recognize that failing to note the negative effects of masculinity doesn’t solely hurt men: It also causes damage to women and other historically oppressed groups. This is because it reifies and re-entrenches dominant ideologies, including that men don’t need help, they don’t need doctors, and they don’t need you to care about them. Gendered social structures can change over time, but they are also reinforcing and self-fulfilling. In order to change how young men treat others, we may have to help them change the way they treat themselves first. Otherwise, the more young men remain transfixed by our current ideologies of masculinity, the more they re-enact them on future generations.

As a future addictions fellow interested in transitional age youth, I am interested in showing young men that there is another way: one that allows them to shed off the chains of the past in order to decide for themselves, each individually, what being a man truly means. I hope you’ll join me. ■